Over two and a half millennium years ago what the Buddha – The Supreme
Enlightened Master- taught during a period of forty- five years has been
studied in various aspects by a long line Buddhist patriarchies dawn
generations of master-pupils lineage, so it is possible to find out in
the canon the aspect of Buddhist psychotherapy takes shape.

Psychotherapy is the only form of therapy it is. If mental disorder
arises in someone, it will be effectively solved by one's own mind of
knowing and seeing one's own defilements with the good co-operation
between oneself and the psychotherapist. That is the first important
factor in the process of healing.

(Mind is the forerunner of all (evil) conditions.
Mind is their chief, and they are mind-made.
If, with an impure mind, one speaks or acts,
Suffering follows one even as the cart-wheel follows the hoof of the
ox.)

(Mind is the forerunner of all (good) conditions.
Mind is their chief, and they are mind-made.
If, with a pure mind, one speaks or acts,
Happiness follows one like his never-departing shadow.)

These two stanzas which are opening of the Dhammapada, were
spoken by Gotama Buddha more than 2,500 years ago. They elucidate
the crucial theme of Buddhist teaching, the human mind. The 'mano'
here also signifies six-fold sense experience that is eye, ear, nose,
tongue, body and mind episode. The happiness or suffering depends on the
attitude of one's own mind: correct or incorect (yoniso-manasikāra vā
ayoniso- manasikāra). If the mind understands in a good way,
happiness arises. On the other hand if the mind interprets in a bad way,
suffering is a consequent result and when the mind is out of control, at
that time mental disorder takes place.

Further, the Buddha was the first one to point out a disparity between
mental sickness and physical sickness. He says that

"Monks, there are these two kinds of disease. What are they? They are
bodily disease and mental disease. People are seen who say they have
been physically healthy for one year, ...for more than one hundred
years. But apart from those whose cankers are destroyed. (i.e the Saint
or Arahants), beings who say that they have been mentally healthy for
even a moment are rare in the world." (AN, Catukka-Nipāta, Roga Sutta No.
157).

The
three cardinal causes of mental sickness could be discovered more than
2,000 years in Charaka Samita. They are: 1: rajas: defilements; 2:
thamas: darkness or confusion; 3: satva: the imbalance of
mind, bile, phlegm. With the technique of analysis of the mind contents,
the mental cause have to be exposed either by the mental patient's
knowing or seeing.

"It
is worthy to note that nowadays, there are in Sri-Lanka a number of
traditional mental hospitals, some of them are run by Buddhist monks."
[1]

Psychotherapy is a combined word of Psychology and therapy according to
Oxford Dictionary and Thesaurus, Psychology has two meanings: 1: Study
of mind, 2: Mental characteristics. Therefore, Psychotherapy means
treatment of mental disorders by the use of psychological method under
some instructions of the Psychotherapist.

It
is worthy to note that: "Freudian psychoanalysis works on the assumption
that when the origin of a personal disorder is known its influence on
unconscious motivation will automatically disappear."[2]
However, in reality it proves that there exist so many unsolvable cases.

The
following is the limitation of the Western Psychotherapy:

II. Limitations
of Psychotherapy:

There are five systems of psychotherapy that are being practiced and
developed during the last two centuries in the Western world. They are:

1: Chemotherapy is
the most popular and intensely used method of psychotherapy.
Psychiatrists use chemicals or chemical compounds to create balance
between the body and the mind of the mental patient.

2: Electroplexy is
also a special therapy; only Psychiatrists can use it. The mental
patients are given electric shocks of short duration from special
electrical devices and they do not notice the psychology of mental
patients.

3: Psychosurgery is
the brain operation with a view to altering or normalizing certain
behavior patterns of mental patients. This method is so dangerous to the
risk of the mental patient that it has not been popular.

4: Behavior therapy: The
behavioral scientists or social psychologists have used the advanced
system of therapy in order to change or remove the symptoms of mental
sickness so that normal behavior would be restored.

5:
Psychoanalysis: According to Freud, Psychoanalysis is called
depth psychology. Some techniques are used to help the mental patient to
become aware of the causes of his mental sickness. It can be used to
analyze experience and behavior of the depth consciousness of mental
patients, especially with the discernment of the dreams and mental
disorders that have the same character of neurotic symptoms.[3]

It has been now proved that the diversity of
mental life between so-called normality and neurotic is only a matter of
degree. This invention based on The Freudian formal saying: "We are all
somewhat hysterical". It sounds like an utterance of Buddhist
introspection (Sabbe puthujjanā ummattakā) "All worldlings are prone to
be mental illness." [4]

Psychoanalytic treatment has been proved to have three limitations such
as: high cost, time-restriction and not good effect in many cases.[5]
In many cases the most it can do is to enable the subject to come to
terms with himself and 'live with' his condition. The limited nature of
its success is indicated by the need to resort to physical treatment for
cases that have passed from neurosis to psychosis, such as electro
convulsive therapy for acute depressive moods, insulin injections for
the early stages of schizophrenia, frontal lobotomy for prolonged
anxiety states and the use of the class of drugs known as tranquilizers
which act upon the vegetative inter neurotic circuits of the brain. In
contrast to the invention of Western psychiatry, Buddhist Psychotherapy
is focused on a high level of the whole individual; since passion is the
causal root of suffering it is required to lessen, and finally uproot
passion. However passion is also the principal stimulating force of
discretion, therefore the first step of the process must be the
replacement of higher purpose for the impaction of the libido and their
subsidiary things.

The
libido – activated craving must give place to the mindfully
directed incitement of the higher mind (Adhicitta). It is here that
Buddhism presents a site of testimonial which Western psychotherapy has
been unable to adjust suitably for its theories- the outlook of moral
values.[6]

Even depth psychology that is closer to Buddhism than to other sciences
deals with the mind only to the dimension of transmuting hysterical
misery into daily non- appeasement or unhappiness. It could not go
beyond that to the superlative form of psychological maturity that is as
deep as that of an arahant- the ideal of psychological superiority in
Buddhism.[7]
Thus, Buddhism especially Abhidhamma- Buddhist psychology- pays much
radical attention to the mind more than any other sciences of human
mind.

III. Concept of
man in Buddhism

Man
is the most honorable creature in the whole world. One should consider
all other men as one's own brothers, as the members of the same great
family of humankind without any discrimination of race, caste or rank.

(It is not by mere birth one becomes an outcast or noble, but by one's
action.)

Being reborn into a certain family, lineage or class or nation a man
should not be looked down upon by another man. In another words, by mere
birth it does not make man noble or ignoble but by three fold actions:
bodily, verbal and mental actions. In Buddhist history there are various
cases illustrated that. Devadatta was born of royal lineage and
attained the five mundane higher powers (Abhiññā), but because of his
jealousy towards the Buddha, he committed grievous crimes and was
swallowed by the earth; Aṅgulimāla was a son of a minister who
became a notorious robber but when he was transformed into a disciple of
the Buddha, he became an arahant - the noblest stage! ...

Thus, man is the architect of one's own future or destiny. According to
Buddhist psychological aspect, the disposition of man is conditioned and
nourished by the action of mind (manas) and as a result the
personality and destiny of man are also likewise decided by the mind.
That has been illustrated in the two first stanzas of Dhammapada.

According to Buddhist doctrine, man is a psychophysical combination of
mind and body (nāma- rūpa). Sensation (vedana), perception
(saññā), mental formation (saṅkhāra) and consciousness (viññāṇa)
are the non-physical factors in man collectively regarded as mind (nāma);
whereas the four great primaries or elements (cattāri mahā bhūtāni)
have their characteristics as extensions (earth- pathāvi),
cohesion (water- āpo), heat (fire- tejo) and vibration
(wind-vāyo). These are the physical factors in man collectively
regarded as body (rūpa).

These five various groups (rūpā or material component on the one
hand and vedanā, saññā, saṅkhāra and viññāṇa on the other)
in which the psychophysical entity called man in analyzable are referred
to in Buddhist texts as khandha (fivefold aggregate). It
constitutes the basic so-called individual or personality.

Man
must be skillful in his own welfare but at the same time he should
cultivate his spiritual life. A locality where there is no chance for a
person to develop his morality is not suitable to choose for one's
living.

A
man should have (kalyānamitta) a spiritual teacherto
instruct him in the moral aspect, and should associate with and serve as
his ideal. A locality where there is such a person to be found is a
suitable to live in.

Association with the wise may prevent one from having mental disorders
to some extent and make progress in the spiritual life. [8]

It
should be also known that the distinction between the worldling and the
arahants is clinging (upādāna). A worldling has been
clinging to sensual and sexual desire, to his viewpoint as well as his
own body; hence his fivefold clinging aggregate (pañcuppādānakkhandhā).
Therefore he is subject to suffering (dukkha) mentally and
physically. The paramount importance is eradication of these clingings
(upādānā), in other words total absence of greed, hatred and
ignorance.[9]

IV. Concept of
taṇhā in Buddhist Psychology and its modern parallels[10]

Psychology-analysis systematically expresses that there are two basic
intuitions which hide behind the evident ego intuition and object
intuition, namely, eros (the unifying intuition- positive
wishes), the intuition that attempts for ever-closer union and
thanatos (or the death with the destructive intuition- negative
wishes) that results in the decay of what is living. The demonstration
of the force of eros is named libido that comes from the
Latin word for 'lust'. The Buddhist term for 'lust' is 'taṇhā'.

There are three kinds of 'taṇhā' that are (Kāma-taṇhā): craving
for sense-delight, (bhava-taṇhā): craving for self-protection and
(vibhava-taṇhā): craving for non-existence. Thus kāma-taṇhā as
explained in Buddhism accords with the libido of Freudian
Psychology.

The
term libido is used to identify the presence of sexual thirst in
man. Libido - sexual thirst is regarded as similar to the force of
hunger, or the will to power, and other such tendencies among the
self-leaning.

With the gradual advance of the libido theory, the term of
sexuality became synonymous with the word love. Sigmund Freud says that
the central part of what is meant by love consists in sexual love with
sexual union as its purpose that is inseparable from this certain
affectionate and friendly stimulus. The love for parents and children,
friendship, love for humanity and even the devotion to abstract ideals
are manifestations of the same instinctive root.

Craving for sense-delight as a demonstration of greed (lobha) and
greed that is a fundamental root (mūla) rouses unhealthful state.
The Buddhist psychological term of 'root' is called as motivation,
motive, force, drive, rousing, instinct, inclination, etc.

The
Buddhist concept of motivation is more intelligible easier to understand
than the Western Psychology concept of man being born of sin.

The
idea of craving for sense-delight as a pleasure tenet is much wider than
the concept of pleasure formed in libido, and the therapy for the
mental illness is much more deep-reaching and fundamental in Buddhism
than in psychology; because psychology focuses on bringing a patient to
his normal manners, while this normal person in Buddhist term is called
a worldling (puthujjana). To some extent a worldling still has
mental sickness until the arahantship is achieved as mentioned in
the Aṅgutara-nikāya (AN, p. p 142-3) The Buddha says in this
world there are beings who are free from bodily suffering on account of
disease for a year... even a hundred years; but it is rarely to find out
who can be free from mental disease even for one moment, except for
those in whom the cankers (āsāva) are annihilated, namely, an
arahant.

Commonly, the libido and the ego-intuition are said to run
through 'the pleasure tenet' and the reality tenet respectively. The
reality tenet expressed in this certain 'reality tenet' is alien to
reality of the Buddhist concept. In Buddhism, this psychological reality
is also a demonstration of craving (taṇhā).

According to final Freudian analysis, the reality tenet that is
substituted for the pleasure tenet does not mean a dethronement of the
pleasure tenet but only the preserving of it. An ephemeral delight,
indefinite in its results, is given up, but only in order to acquire a
convinced pleasure coming later.

The
concept that ego - intuition demonstrates itself as self-protection,
self-adoration, self-assurance, self-admiration, self-constant etc shows
how far it searches pleasure and how far it is conditional on craving.
In the certain aspect, it is only a form of craving named (bhava-taṇhā):
craving for self-protection in Buddhism.

During two decades, Sigmund Freud developed several methods for reaching
the unconscious that is similar to the concept of the unconscious in
early Buddhism. It means the concept of sleeping predisposition (anusaya)
and the concept of mental tendency (mano-saṅkhāra). Anusaya and
mano-saṅkhāra like unconscious lie dormant in the deeper level of
the mind and have an effect on manners of the worldlings (puthujjanā)
without their comprehension. Thus, they become the parts of a feature of
unconscious rousing. Nevertheless, the mano saṅkhāra have a
broader scope extending through countless births which clinical
psychology has not unveiled still. Among the seven anusaya (D.III
p.254) vicikicchānusaya (anusaya of skeptical doubt) and
avijjānusaya (anusaya of ignorance) stay beyond the range of
psychology, of the remaining five anusayas,kāmarāgānusaya
(anusaya of sensuous craving corresponds to the libido,
paṭighānusaya (anusaya of antipathy), the thanatos, and
diṭṭhānusaya (anusaya of wrong view or conjecture) and mānānusaya
(anusaya of conceit), and bhavaragānusaya (anusaya of craving for
existence), the ego.

The
following is the comparisons of kilesa, anusaya and saṃjoyana.

Kilesa

Anusaya

Saṃyojana

1. Lobha / rāga

1. Kāmarāga

1. Kāmarāga

2. Bhavarāga

2. Rūparāga

3. Arūparāga

2. Dosa/paṭigha

3. Paṭigha

4. Vyāpāda

3. Moha/avijjhā

4. Avijjhā

5. Avijjhā

4. Māna

5. Māna

6. Māna

5. Vicikiccha

6. Vicikiccha

7. Vicikiccha

6. Ditthi

7. Ditthi

8. Sakkāyadiṭṭhi .

9. Silabbataparāmāsā

7. Thīṇa

10. Uddhacca

8.Uddhacca

9. Ahirika

10. Anottappa

The
first three fetters in the above list represent the first defilement
while the eighth and the ninth fetters represent the sixth defilement.
Others are identical except the tenth defilement that is not found among
the six basic passions, but is given as one of the ten passions
enumerated by the Theravadins. [11]

The
anusaya are so-called passions that lie dormant in a person's
stream of consciousness (citta-santana) that is called
bhavaṅga citta in Theravada and the Alāyavjñāṇa in the
Yogācāra school. It is like a sleeping serpent existing from unknown
time but it may cause the mental patient to act in an unreasonable
manner.

Thus, every worldling has potential craving (taṇhā) or
defilements (kilesa) the cardinal importance is how much one can
be able to control oneself. The way to control oneself is nothing than
mindfulness.

Mindfulness and awareness in every rousing of the mind is their target.
If one can be able to detect at the first moment of every response of
one's mind, which is very useful to one's own cultivation and one's
purification of mind.

On
the other hand if one fails to detect at the time of its rousing in
one's mind, one can be carried away by verbal action and bodily action.
Even in such a state if one is unable to control it, it means one
becomes mental illness.

On
the superficial aspect, a near and prime cause of mental disorders is
modern trading advancement that is ceaselessly stimulating and
propagating desires which worldlings (puthujjanā) are unable to
satisfy fully and become frustrated. However, according to Buddhist
Psychology the worldling is identified by mental reactions of craving
for states which are impermanent (aniccā), subject to suffering,
devoid of reality and inherently impure. These one mistakenly assumes to
be permanent, to engender happiness and endowed with self-existence.

One's yearning for them accompanied by mental cankers
(āsava),
defilements (kilesa) and psychological fetters (saṃyojana),
in Buddhism are seen as the root causes of wrong action and consequent
misery.[13]

Accordingly in Buddhist Psychology mind is not just cognition. It
embraces one's emotion as well as all unconscious mental-emotion
reactive motifs. Emotions arise at the scene where mind and body
encounter. It is the body's reaction to one's mind or reflections of
one's mind in the body. For example, an antipathy thought will cause a
process of energy in the body called anger. The body is getting prone to
conflict.

Research has proved that robust emotions even cause fluctuation in the
biochemistry of the body. The biochemical fluctuation exemplifies the
visible aspect of emotion. Obviously, it is not usual to be conscious of
all thought motifs, but it is beneficial to one if one can watch one's
own emotions so that one can bring them into awareness.

Failing to watch one's own emotions and often being carried away by
unwholesome emotions such as: greed (lobha) or sensuous desire
(kāmacchanda), hatred (dosa) or ill-will (vyāpāda),
laziness and apathy or sloth and torpor (thīna-middha), agitation
and hesitation or restlessness and w6rry (uddhacca-kukkucca) and
mistrust or doubt (vichikicchā). In other words one may be
captured by one of these five hindrances (nivaraṇa) and one's
mind becomes disorder!

The
Buddha teaches in the Satipaṭṭhāna sutta of the Majjhimā Nikāya
as follows:

"And how, bhikkhu, does a bhikkhu abide contemplating
mental objects as mental objects? Here a bhikkhu abides
contemplating mental objects in terms of the five hindrances. And how
does a bhikkhu abide contemplating mental objects as mental
objects in terms of the five hindrances?

Here, there being sensual desire in him, a bhikkhu understands:
'There is sensual desire in me', or there being no sensual desire in
him, he understands how there comes to be the arising of unarisen
sensual desire, and how there comes to be the abandoning of arisen
sensual desire, and how there comes to be the future non-arising of
abandoned sensual desire.

'There being ill-will in him... There being sloth and torpor in him...
There being restlessness and remorse in him...There being doubt in him,
a bhikkhu understands: 'There is no doubt in me; or there being
no doubt in him, he understands: 'There is no doubt in me', and he comes
understands how he comes to be the arising of unarisen doubt, and how
there comes to be the abandoning of arisen doubt, and how there comes to
be the future of non-arising of abandoned doubt."[15]

To
note mindfully, and immediately, the arising of one of the hindrances,
as recommended in the preceding text, is a simple but very effective
method of countering these and any other defilements of the mind. By
doing so, a brake is applied against the uninhibited continuance of
unwholesome thoughts, and the watchfulness of mind against their
recurrence is strengthened. This method is based on a simple
psychological fact that is expressed by the commentators as follows:

"A
good man and an evil thought cannot occur in combination. Therefore, at
the time of knowing the sense desire (that was arising in the
preceding moment) that sense desire no longer exists (but only the act
of knowing)."[16]

The
five hindrances keep pushing, jabbing, knocking one down all the time
until one's proper attention and fully understanding them.

The
just arising and vanishing is according to conditions in the mind. If
one patiently endures through the transient conditions then things
change automatically on their own and one has the openness and charity
of mind to act spontaneously, rather than reacting to conditions. With
bare observation, with awareness, thing go on their own, one doesn't
have to get rid of them because that begins, ends. Just be patient with
them and allow thing takes their natural course into cessation.[17]

The
more one is identified with one's thinking, one's like and dislike,
judgment, interpretation and proliferation of mind, which is to say the
less present one is as the watching consciousness, the stronger the
emotional energy will be, whether one is able to be aware of it or not.

The
unhealthy emotional and motivational tracks become toughened by the
incessant repetition of motifs of manners that escort their expression.
A mannered shift at the level of overt expression of a person's emotion
becomes needed in order to enfeeble or to root out the unhealthy
emotion.

In
Buddhism the problem of dukkha has a close relationship to the
level of cognition and the nature of motivational and emotional effect
on the individual's disposition. Gotama Buddha teaches that
emancipation from the dilemma of human anguish is possible by a
conversion at the level of understanding influences on motivation and
emotion as well, shifting the total motifs of man's behavioral reactions
and feelings.

According to Buddhist terminology such a conversion is identified at
Paññā-vimuṭṭi (emancipation through wisdom) and Ceto-vimuṭṭi
(emancipation of mind) can be comprehended as the emancipation of a
conversion in the emotional edification of disposition.

It
is relevant to assume āsava (cankers) under the Buddhist
psychology of emotions as it is plainly identified that they are mental
phenomena which cause feelings of panic, irritability and annoyance (vighata
parilaha) to anyone influenced by them.

There is the enumeration of four kinds of āsava (cankers) in the
Pali canon: kāmāsava (those related with sensuality),
bhavāsava (those related with eternal existence), diṭṭhāsava
(those related with dogmatism or wrong view) and avijjāsava
(those related with ignorance or confusion).

Buddhism pays very careful attention to the introspective observation of
the stream of consciousness and experience in its healing of
psychological phenomena. From pragmatic viewpoint Buddhism considers
man's capacity to rectify what goes on in his flow of consciousness as a
very dire step in redirecting his emotions and behavior.

Mental patients not only are unable to be mindful of the arising of
emotional experience but also are carried away by its domination over
their verbal and bodily expressions.

Vipassanā or Insight meditative training
implies the development of mindfulness as regards all mental as well as
physical processes in connection with one's daily activities.

Mindfulness in time is a good detector to sense the arising of unhealthy
emotions such as longing and antipathy at their very inception thus
their outwards flow can be stopped by practicing mindfulness (yāni
sotāniṃ lokasmiṃ, sati tesaṃ nivaranaṃ).

Insight meditation in Theravada Buddhism is the most pragmatic
observation of emotion at the time of its rising, existing and passing
away. Such bare observation over the process of unhealthy emotions has
the result of hindering them going beyond the boundaries of the mind and
clearly showing themselves in overt deportment.

Selection not exhaustion is the Buddhist healing. Since its relation
with emotion is controlled by ethical and practical point of view.
Buddhism pays no notice of all diversity of emotional and motivational
aspects of life but with the selective dealing of them to attain
happiness and eliminate suffering of humanity. Thus Buddhist
Psychotherapy has made a very significant contribution to human culture.

VI. The process
of the ancient healing- psychotherapy.

1. Introduction:

Psychotherapy is a psychological process that helps to change the mental
patient's illusion or hallucination. That is the concept of 'I' and
'mine', happiness and permanence. With the guidance of the
psychotherapist, this process helps the mental patient gradually
understand and accept the three cardinal aspects of all things:
anicca (changing, impermanent), dukkha (suffering) and
anatta (non -self); however such concepts have no meaning to the
mental patient if these terms are used they may not responded to help.
Their purpose is to be able to keep in their mind the concept of ego or
self, but without suffering involved.

At
the first session, the aims of mental patient and the psychotherapist
are at variance. The psychotherapist should make the mental patient
burst out his obsessive story and listen to him attentively without
taking down notes in front of him.

The
psychotherapist should ask the mental patient some questions concerning
the change in some visible things or persons around him. Gradually the
psychotherapist helps the mental patient to be aware of the law of
change...

When the mental patient comes to accept the law of change (anicca),
with the delicate guidance of the psychotherapist, the mental patient
slowly realizes how much suffering there is in himself as well as in his
near and dear ones.

The
task of psychotherapy is one of reconciling the out-bursting emotions of
the mental patient. It is hoped that the development of communication
and relationship among the psychotherapist, mental patient and his
family will bring him soon to the normal state.

2. The function of the psychotherapist

Those who would like to help others by this approach needs first of all
to become familiar with the technique and have much personal experience
in Insight Meditation so that their radiation of wisdom and compassion (karuṇa)
will attract the attention of the mental patient.

Restoration of normalcy and mental health of the mental patients are the
purpose of the psychotherapist. All worldlings have their own mental
defilements such as greed, hatred, conceit...and for a long time they
can control themselves; such person are not in the domain of
psychotherapist but those who are unable to control their defilements
and violently or unconsciously carried away by them in their verbal and
bodily expressions are in their real domain.

The
targets of the psychotherapist is to help the mental patient be capable
of managing their own defilements and to be active as well as understand
with an average level of self- awareness.

Making of cartharsis in the mental patients, the psychotherapist must
not tell the carthasis of the mental patient to anyone and be a
sensitive listener and base on that data to classify the temperament of
mental patients such as:

Then, the psychotherapist should choose topics to converse according to
their inclinations.

The
psychotherapist at the beginning of developing communication has to show
his empathy to the mental patient with a great enthusiasm to know his
situation and soothe him from suffering due to sickness by forgiving and
letting go and opening revaluation for him.

The
psychotherapist is endowed with the understanding the four Noble Truths,
and able to diagnose a sickness (Dukkha Sacca), designate its
cause (Samudaya Sacca), say whether the sickness is curable (Nirodha
Sacca) and trace the means of cure (Magga Sacca).[18]
Then, the psychotherapist should make the mental patient understand that
every thing is subject to change therefore the mental patient's sickness
also will be changed.

Good communication has to be set up in the triangular relationship among
Psychotherapist (P), to mental patient (M) and his family (F): from P to
M, from (M) to (P); from (P) to (F), and from (F) to (M), from (M) to
(F) and from (F) to (P).[19]

There are impediments that prevent the psychotherapist from
understanding the patient. Passing of the mental patient's emotions on
the psychotherapist is a distinctive obstacle that all psychotherapists
have to face. For instance, the antipathy or lust or even sexual thirst
that exist in the mental patient, may shift such emotions on to the
psychotherapist.

Therefore the psychotherapist should ask the mental patient to keep the
eyes closed during the time of conversation about thirty minutes. After
a break for drinking some kind of beverage, he should suggest the mental
patient do breathing exercise with him either sitting on a chair or
lying on a bed without pillow: breathing in and out normally five times
and then breathing deeply and keeping the breath in the chest for a
while and breathing out strongly.

This exercise is good for blood circulation and many functions of
internal organs of the body. It is required to do for ten or fifteen
times either after getting up or before bed time. If it is necessary it
can be done twice a day.

The
psychotherapist must practice patience on the mental patient, carefully
and attentively listen to the bursting words of the mental patient and
have capacity to detect the character of the mental patient by noticing
on their facial reactions and bodily behaviors.

Moreover, the psychotherapist is able to get interpretation of the
mental patient's dreams and find out its cause hidden in the
unconscious.

This process of healing is the process of cooperation between the
psychotherapist and the mental patient so the psychotherapist should ask
the mental patient whether he wants to come again or not. If he agrees,
the psychotherapist should give an exact appointment and good
expectation about the mental patient's neat and clean appearance and
polite behaviors.

No
one in the world is totally free from pain and sorrow during one's life
span. Isn't it important to learn how to get along with them rather than
trying to get away them?

The
suffering that the mental patient creates now is always some kind of
non-acceptance, some sort of strongly unconscious resistance to what is.
It is some sort of negative thinking or incorrect judgment. The
intensity of the suffering relies on the level of non-acceptance or
resistance to the present moment. Their mind always tries to search for
a way to escape from the Now.

That is the main core of all kinds of mental disorders. Therefore, the
simple principle is to accept whatever the moment comprises as if it is
chosen already. Always get along with it not against it. Make it
friendly. This will be the wonderful transformation for your whole life.

a. Non-identification

The
pain-body is survived by the unconscious identification of the mental
patient on any experience that produces with its own sort of energy,
anything that creates further pain in whatever form: anger,
destructiveness, hatred, grief, emotional drama, violence, and even
illness. At the moment one observes it, sees it for what it is, and
feels its energy field within oneself, one penetrates into it then the
identification is broken. A higher dimension of consciousness has come
in. One is the witness or the watcher of pain body. One has found out
one's own inner strength. One has accessed the now.[21]

In
the Pali canon we find out several times the Buddha claims the
importance of mindfulness in various cases: Mindfulness is only the way
(ekāyano ayaṃ maggo) for the purification of beings (sattānaṃ
visuddhiyā), for the overcoming of sorrow and lamentation (sokapariddevānaṃsamātikkhamāya), for disappearance of pain and grief (dukkha
domanassānaṃatthaṅgamāya) for reaching the Noble Path (ñāyassa
adhigamāya), for the realization of Nibbāna (nibbānassa
sacchikiriyāya).

Pāṭācāra on hearing the Buddha's calling
her 'bhāgiṇi', this word was used in very time by the Buddha
touched the right chord so that she immediately regained awareness and
on listening to his teaching, she not only overcame her sorrow and
lamentations but also was established in the fruition of Stream-entry.[22]

Ven. Anuruddha was afflicted with a grave illness accompanied by
painful physical sensations. He was however able to tolerate calmly
these painful sensations. A group of monks inquired how he was able to
do this. Ven. Anuruddha declared that he was practicing the four
foundations of mindfulness.[23]

At
the beginning one practices mindfulness, one may not overcome pain, pain
may not disappear; but with mindfulness one will be able to get along
with the pain and accept it. Like that, if one's mind is not disturbed
by physical pain, pain is virtually non-existent.[24]

In
Mahāsatipaṭṭhāna Sutta (DN, sutta 22), mindfulness on the body is
taught in six ways or fourteen ways as follows:

- Mindfulness of breathing
(ānāpānasati)- Mindfulness of the postures of the body (iriyapātha)
- Mindfulness with clear comprehension (saṃpajāṇa)
- Reflection on the repulsiveness of the body (paṭikūla- manasikāra)
- Reflection on the four material elements (dhātu-manasikāra)
- Nine cemetery contemplations (sivathikā-manasikāra)

Out
of these six ways of developing mindfulness, mindfulness on the
breathing process is of pragmatic therapeutic value. This way is easy to
practice and easy to understand for the mental patient.

b. Application of mindfulness in sitting and lying

The following is the technique often used by Dr. H S S. Nissanka - the
well-known psychotherapist of Sri-Lanka:

First of all, the psychotherapist should ask some questions to bring the
attention of the patient on the body by noticing what is happening in
the abdomen while breathing in and out. The mental patient either sits
on a chair or lies in a bed comfortably without pillow with half-closed
eyes. The psychotherapist softly guides the mental patient to breath in
and out comfortably, because breathing comfortably, your body becomes
relaxed, noticing in your head and the breathing in and out comfortably,
because breathing comfortably your head becomes relaxed. Continue like
this, going down to the neck, upper back, lower back, legs and feet, and
then going up to knees, belly, chest and face. Then the psychotherapist
asks the mental patient:

Can
you detect any pain in your body?

Pay
much attention into that pain and breathing in and out comfortably, that
pain- place becomes relaxed.

Practice in this way about fifteen minutes.

c. Application of walking in
mindfulness

The
psychotherapist should get the mental patient to walk on a plank of
about 4 or 5 meters in length and about 10 centimeters in height.
Gradually should increase the duration of time. This practice exercises
much attention and bodily- balance. Those who have used medication for a
long time will get much benefit from this kind of meditation (iriyapātha).

A
well-educated lady, after using chemical medicine for a long time, her
body got too fat and she became a mental patient. When instructed she
has practiced this walking meditation, her weight gets lessened monthly
and normalcy is restored

Other ways may not be suitable to the mental patient. In short,
mindfulness on the body (kāyānupassanā) is the way for cooling
down and achieving normality of physical manners of the mental patient
concerned in order to restore mental health.

d. Symptoms: (Phenomena)

The
psychotherapist can use Mindfulness meditation techniques in manifold
ways. First of all, the approach is very patient-centered; the patient
is allowed to be free and dignified to work with himself under the
psychotherapist's guidance. This, of course is efficacious because of no
confinement of psychotherapy to the hours when both meet together. The
course of therapy is more one of the patient's seeing; knowing and
accepting his mental processes and then allowing them ameliorate and
improve in new motifs of thinking, saying and doing that are healthy for
him. He was not able to be aware of what he had done in verbal and
bodily action, so that was the main reason it led him to become a
criminal.

A slightly disguised set of Satipaṭṭhāna techniques was utilized with a
23-year-old male patient who had been hospitalized for extreme frequent
quarrels, fighting, and alcohol abuse, which had occasionally led to
brief periods of loss of memory. This young man, who was married and had
young children, had been very much touchy and explosive at home, often
loosing his temper over petty things and striking out physically and
running out of house for up to three days.

A
typical thought in habitual motif was for him to go to a bar with
friends for a few drinks during the evening and become intoxicated. In
this condition he would often steal a car, get into a fight, or even
threaten homicide, but he failed to have any memory of these acts the
next day. He was hospitalized twice after such unlawful behavior.

During the first group and family therapy sessions, numerous
identifiable marital problems became evident; these were the focii of
the family therapy. Group and individual therapy revealed personal
problems of expressing anger, projecting self- image, enmity toward
women and extreme competitiveness with other men.

Since it did not appear that this man would be quick at receiving the
usual mindfulness approach, a softened version was tried. He used to get
angry but later denied getting angry and then expressed the denial
explosively. Later the young man said that he did many things he was
unable to understand.

e. Methods of treatment (Cittānupassanā and Dhammānupassanā)

It
was suggested that he attempt to look at and label the emotions he
experienced during the next few days. He tried that suggestion and
reported that what he felt most of the time was fear (of people or
sometimes of nothing he could identify) and psychological pain. He was
instructed to keep watching and naming emotions.

After some weeks, he began to see anger arising in certain interpersonal
situations. He was also able to experience his feelings of irritability
and to see what events produced them. Most important, he began to be
aware that he did not express anger and often was not aware of it until
it had overwhelmed him. He was taught to express in words his anger in
order to give an outlet as he experienced it, and to view anger as
something all people normally feel.

This seemed to free him for progress in psychotherapy. He stopped seeing
his problem as alcoholism and spoke of alcohol intoxication as another
way of trying to hide from his anger. Soon he stopped mentioning alcohol
at all.

Other mindfulness techniques were then used with this man, particularly
thought contemplation, which made him aware of his ineffective and
inaccurate self-image. This helped him to start correcting
misunderstandings about male-female relationships.

f.Results

At
the end of eight weeks of this treatment, he took a job. Ten months
later, he was still functioning effectively at home and at work, with no
recurrences of drinking, fighting and loss of memory. This mindfulness
techniques utilized here constituted one part of an overall therapy
program which proved to be effective.

g. Relapse

A
few months after this case history was published, the man again behaved
capriciously. Even at the request of his family and friends, he refused
to seek help and continued to encounter more problems, cardinally with
his family and his job. He finally fired a rifle through the window of a
house; seriously injuring a woman he did not know while apparently
trying to injure his wife. At this writing, he is confined awaiting
lawsuit.

h. Comments

This case is isolated but striking example of a person who did not
continue to develop after terminating therapy, but in stead slowly lost
the benefits he gained. The psychotherapeutic gains achieved through the
use of this technique, like most other forms of therapy, can wear away
gradually over time if the patient ceases to practice mindfulness and
stop developing.[25]

The
above- mentioned case shows that this mental patient is so influenced by
external stimulus as well as his sudden emotion that he had acted like a
puppet without knowing or seeing the result of his verbal and bodily
actions. According to Buddhist Psychological terms, he used violent
agitation (uddhacca) to cover his latent defilement (kilesa)
of anger (dosa). When he comes to see it and know it, it
disappears by itself.

Worldlings often long for something new, unusual, attractive... and get
bored and neglect daily activities; but when something happens out of
order they are unable to work well, confined in one place, restricted
and have to depend on others. At that time they come to know how
precious and noble life is!

When he is in prison he comes to know the value of freedom, when his leg
is broken he comes to know the value of strong legs, when he struggles
with sleep he comes to know the value of sound sleep, when he is unable
to swallow he comes to know the value of mindful eating…

In
the case of the mental patients, their defilements are so veiled by
ignorance and overwhelmed by craving that they act abnormally which lead
them to either a tragic and traumatic crisis or a horrible and terrible
situation.

Since all 'worldlings' are deranged, what we are concerned with in
energetic psychology is the degree of derangement and its underlying
causes. This is the case also in Buddhist psychology.[26]

VII. Conclusion

In
this world the human mind moves selectively, grasping this rejecting
that, due to individual preferences of habit and previous
self-conditioning. The consciousness predominating factor known to
Buddhism as Avijjā (nescience), Moha (confusion or
ignorance) or Vipallāsa (misapprehension) is essentially a
condition of mental disorder, a hallucinatory state. The Pali axiom
"Sabbe puthujjanā ummattakā."[27]
(All worldlings are deranged), identifies that the entire object of
Buddhism is to implement mental therapy to a condition which accedes to
this rule and is in reality nothing but a state of universal delusion.[28]

* * *

Therefore, the process of healing is to get the mental patient to know
and see his own emotion (kilesa) by labeling whatever is
happening in his body and mind: postures, sensations in his body and
feelings, emotion in his mind with bare observation and
non-identification.

In
other words, what was unconscious, unknowing unseeing before becomes
conscious, knowing and seeing. Thus, mindfulness is practiced at random
– labeling whatever is happening at the present moment in his daily
activities and his working mind.

With the technique of fourfold mindfulness: on the body, on the feeling,
in the mind and in the dhamma, slowly and gradually the mental patient
can recognize by oneself and then on seeing and knowing his own
defilements, the mental disorders will be cured and restored soon.

The
cardinal importance is maintenance of constant mindfulness, calmness and
clearness in all threefold actions: mental, verbal and bodily. The
length of time and intensity of mindfulness one can be with them will
determine one's control of oneself. With the conscientious practice of
the above technique relapses have no room to appear.

The
healing begins when the mental patients come to know how to
observe their own mind, how often they behave like unrestrained
disputants steadily opposing each other and denying listening to the
other side's arguments because of their lack of courage to accept their
practical, moral or intellectual reasoning. If they continue to look
into more carefully their mind more carefully, their thoughts or
judgments, they will have to recognize that many of them are just the
product of habit, led by prejudices of intellect or emotion, by their
pet liking or disliking, by laziness or selfishness by unsound or
cursory attentions.

It
will convince one the urgent need for methodical mental culture. It is
in daily life little heedlessness in thought, words and deeds going on
for many years of one's life, that is mostly responsible for untidiness
and confusion in one's mind. This heedlessness creates the trouble and
allows it to continue.

The
dark and untidy corners of the mind are the hideaways of one's most
dangerous enemies and one can be attacked unconsciously and much too
often defeated by them. That dusky domain peopled by unsatisfied thirst
and repressed jealousy, by hesitation, whim and many shady figures
shapes a background for uprising passions such as lust, antipathy and
confusion.

These defilements often take refuge and find support in the unrestrained
dusky domain of the mind. Usually one tries to ignore it and to depend
on the nullifying energies of one's surface mind. But the only sound
psychological therapy is to face it – with mindfulness. Nothing more
challenging is needed than to acquire the practice of directing bare and
pure attention to these elementary thoughts as often as possible. The
simple fact should be known that two thoughts are unable to coexist at
the same time: if the clear light of mindfulness is present, there is no
room for mental dusk.

When maintained mindfulness has safeguarded a firm foothold in one's
mind, one may replace those elementary thoughts, moods and emotions by
purposeful beneficial thoughts. This procedure of bare and pure
attention is very basic and efficient; the challenge is only the
constancy in utilizing it.

It is said that prevention is better than treatment; therefore all of us
should train ourselves according to what the Buddha teaches Bāhiya of
the Bark- cloth as follows:

"In the seen will be merely what is seen; in the heard will be merely
what is heard; in the sensed will be merely what is sensed; in the
cognized will be what is cognized..."[30]

At
the first hearing, it sounds very simple; but when it is in the
application of one's daily activities, it requires the long process of
self- cultivation and self- purification.

-ooOoo-

VIII.
Supplement

The
discourses of the Buddha contain numerous features of modern
psychotherapeutic processes: asking, questioning, having discussion,
giving explanation and counseling, etc.

In any cases, this psychotherapeutic process does not seem to apply
equally to physically ill laymen. However, the enlightener's physical
illness was cured quickly by the power of Dhamma as mentioned in
Samyutta Nikāya. There are three sermons on The Factors of Enlightenment
concerning the Elder Kassapa The Great, The Elder Moggallāna The Great
and The Elder Cunda The Great respectively.

In the first two cases, The Elder Kassapa and The Elder Moggallāna were
ill, suffering grievously sick; The Lord Buddha reminds his two close
disciples respectively about the seven factors of enlightenment. After
listening to these sermons their serious sickness disappeared, thus both
could recover by reflecting the power of the factors of enlightenment.

In
the third sermon, the Lord was ill at that time, suffering grievously
sick The Elder Cunda came to see the Buddha, the Buddha spoke thus" May
the factors of enlightenment become clear to you, O Cunda."

After the Elder Cunda recited this discourse, the Lord Buddha's illness
too was cured. The Buddhist like to receive treatment by requesting
monks to recite sermons and in some cases, it shows beneficial results.

Nowadays this way often followed by Buddhists; when someone in the
family gets ill without knowing its cause, they often request Buddhist
monks or nuns to recite Paritta sutta. In some cases it shows very
useful results. In many Buddhist countries, there is a custom to recite
Aṅgulimala sutta to pray for the good of the expectant mother as well as
her baby.

It
is worthy to know that there are a number of unbearable diseases when
the patient is on the verge of death or leads the life of unbearable
sickness. In such situations they make strong determination to better
their practice till death or they will die in Dhamma or their illness
will be healed. With some instructions of Mahasi Sayadaw or his
outstanding disciples, many patients with strong mindfulness practised
very ardently, their illnesses subsequently were healed.

These cases are described in detail in the book of Dhamma Therapy
by Mahasi Sayadaw and his disciple Ven. U. Paṇḍita with the well-known
book- In This Very Life and so many cases I had seen at the
Santisukha Meditation Centre - Mingaladon Township in Myanmar conducted
by the eldest noble disciple of Mahasi Sayadaw - Ven. U. Kosalla and his
outstanding disciple- Ven. U. Tejaniya. It may not be mentioned here
because of the limitation of this study.